Injuries to the middle and terminal (end) portions of the thumb and other hand digits are relatively commonplace, with the number of treatment procedures for these types of injuries believed to number in the thousands per day in the United States alone. Examples of such injuries include lacerations, abrasions, avulsions, crush injuries, fractures, burns, and even partial amputations. The types of physicians and surgeons treating these types of injuries can include primary care physicians, emergency medicine physicians, general surgeons, plastic surgeons, trauma surgeons and orthopedic surgeons in offices, hospital operating rooms, emergency rooms, and even urgent care clinics.
Conventionally, a patient is given an anesthetic that can include a digital or regional block and/or a local anesthetic with LIDOCAINE or MARCAINE®. The hand and fingers are prepped and draped. A sterile rubber band(s) or Penrose drain (which is a thin-walled rubber tube) is used to stop arterial blood flow to the affected digit. This is done by wrapping the rubber band or Penrose drain around the proximal volar (palm) surface of the digit and clamping with a hemostat. When the procedure is complete, the hemostat is unclamped and arterial blood flow is restored.
Unfortunately, both the rubber band and the Penrose drain have a tendency to roll up as they are stretched axially, which can apply increased pressure on the finger or thumb as the surface area over which the force is applied decreases (it may be described as being similar to a wire being wrapped about the finger or thumb). In addition, use of these types of tourniquets may be such that the external pressure applied to the finger or thumb is not well controlled and may be excessive or beyond the pressure required to stop arterial blood flow. Unfortunately, when excessive pressure is applied to a small region, tissue and/or nerve damage can occur, particularly during relatively lengthy procedures.
In addition, other factors are influencing hand surgery that question the suitability of conventional digital tourniquets. For example, the population is aging and older patients tend to have tissue with atherosclerotic arteries that may be able to withstand less external pressure compared to a younger patient's tissue. In addition, health care costs are rising and more surgeries are being done in an outpatient or office setting, which are less likely to have access to specialized (costly) equipment. This trend may result in more local and digital blocks being used to treat injuries to the digit, which will likely increase the use of digital tourniquets.
In view of the foregoing, there remains a need for digital tourniquets that can provide sufficient occlusion pressure in an easy-to-use and economic manner.